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CC BY 4.0 · J Neurol Surg Rep 2025; 86(04): e206-e213
DOI: 10.1055/a-2713-5787
Case Report

Tetraventricular Hydrocephalus Due to Idiopathic Fourth Ventricle Outlet Obstruction: A Case Report and Literature Review

Authors

  • Guramritpal Singh 

    1   Department of Neurosurgery, Shree Ram Neuro Centre, Jalandhar, Punjab, India

Funding Information The author declares that the contents of the article were written in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Abstract

Introduction

Tetraventricular hydrocephalus happens due to the fourth ventricle outlet obstruction. Idiopathic fourth ventricle outlet obstruction (IFVOO) is a condition where no clear-cut etiology for fourth ventricle outlet obstruction can be found. The etiopathogenesis of IFVOO is unclear. There is no clear-cut consensus regarding the treatment practices for its management. These cases present a diagnostic dilemma to the treating neurosurgeon and are thus often managed inappropriately. This study aims to review the existing literature regarding this condition, illustrating with a case from our hospital.

Case Details

We present a case of a 50-year-old female who presented to us with the chief complaints of headache, difficulty in walking, with an inability to balance while standing and walking, diplopia, and three episodes of loss of consciousness for 6 months. A brain MRI was done, which was suggestive of dilatation of all ventricles with obstruction at the foramina of Luschka and Magendie. She underwent a right-sided, medium-pressure ventriculoperitoneal shunt at our hospital. Postsurgery, there was immediate improvement in her symptoms.

Conclusion

IFVOO is a rare cause of tetraventricular hydrocephalus with an unknown cause. Endoscopic third ventriculostomy (ETV) appears to have a higher risk of failure in such cases. Fenestration procedures after craniotomy and shunt procedures are still effective in their management. ETV is still an alternative to the above-mentioned procedures. To confirm these conclusions, larger studies involving multiple hospitals and institutes are required.

Keywords

idiopathic - fourth ventricle outlet obstruction - hydrocephalus - Luschka - Magendie - endoscopic third ventriculostomy - foramina


Publication History

Received: 01 May 2025

Accepted: 21 September 2025

Article published online:
13 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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